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In a widowed family, the surviving parent and children face the loss together. However, most previous research in bereavement has focused on individual experiences. Although the family perspective has been introduced into the field, neither theories nor empirical research has explored mutual interaction. Dyadic coping reflects the family perspective and has been proven to be an influential factor in couples facing life adversities. Nevertheless, it has not been explored in the context of bereavement-specific stressors, including loss- and restoration-related stressors, nor in the parent–child relationship. This research is the first exploration of parent–child dyadic coping in widowed families in the bereavement context and aims to form a comprehensive conceptualization of parent–child dyadic coping following bereavement. Qualitative semistructured interviews were conducted with 20 parents and children from widowed families in mainland China (11 surviving children and nine widowed parents, representing 19 families). Constructivist grounded theory was used to guide the analysis. The main themes identified were dyadic coping-related cognitions, loss-oriented dyadic coping, restoration-oriented dyadic coping, and contextual factors. Three foci (thou, we, and I) were identified for both loss- and restoration-oriented dyadic coping. A conceptualization model of bereavement dyadic coping within widowed families was developed. This study extends the single I-coping perspective in bereavement coping to a we-coping perspective, provides an interactional- and operational-level knowledge on dual-process coping, acknowledges the bilateral interaction in parent–child relationships, and offers implications for bereavement support practice for widowed families. [ABSTRACT FROM AUTHOR]

Objective: Living the final days of life being cared for at home is a preference expressed by many. The data on the effectiveness of home-based end-of-life care (EoLC) intervention to improve the holistic conditions of terminally ill patients are scanty. This study sought to evaluate a psychosocial home-based EoLC intervention for terminally ill patients in Hong Kong. Methods: A prospective cohort study was conducted, applying the Integrated Palliative Care Outcome Scale (IPOS) at 3 timepoints (service intake, 1-month, and 3-months after enrollment). A total of 485 eligible, consenting terminally ill people (mean age = 75.48, SD = 11.39) were enrolled, with 40.21% (n = 195) providing data at all 3 timepoints for this study. Results: Decreasing symptom severity scores were observed for all IPOS psychosocial symptoms, and most physical symptoms, over the 3 timepoints. Improvements in depression and practical concerns had the highest omnibus time effects (F > 31.92, P <.01) and T0 to T2 paired comparison effects (Cohen's d > 0.54, P <.01). Physical symptoms of weakness/lack of energy, poor mobility, and poor appetite also showed significant improvements at T1 and T2 (Cohen's d : 0.22-0.46, P <.05). Bivariate regression analyses showed that improvements in anxiety, depression, and family anxiety were associated with improvements in physical symptoms of pain, shortness of breath, weakness/lack of energy, nausea, poor appetite, and poor mobility. Patients' demographic and clinical characteristics were not associated with changes in symptoms. Conclusions: The psychosocial home-based EoLC intervention effectively improved the psychosocial and physical status of terminally ill patients, irrespective of their clinical characteristics or demographics. [ABSTRACT FROM AUTHOR]

This study examined the relationships between hope and the emotional reactions of bereaved Chinese people in Hong Kong. Three groups--a clinical bereaved sample (n = 140), a general bereaved sample (n = 152), and a non-bereaved comparison sample (n = 144)--were included. Significant differences in 3 hope measures, hope (pathway), hope (agency) and hope (total), were found between the 3 groups. Moderately strong correlations were found between hope measures and emotional reactions. A mediating effect for hope (agency), but not for hope (pathway) and hope (total), was found in the relationship between bereavement. Possibilities for working with Chinese bereaved people and implications for research and training were discussed. (Contains 6 tables and 1 figure.)

Contrary to the belief that the Chinese do not share emotionally intense experiences, findings from a cross-sectional study of 292 respondents who lost either a spouse or a parent in the previous 2 years in Hong Kong indicated that only 10% did not share their bereavement experiences with another person. The physical health and emotional state of non-sharers was found to be no different to those who shared. In addition, the Chinese are believed to limit their social sharing of personal experiences to family members only. In our study, we found that for those who shared, the persons they shared most with were their best friends, siblings, and professionals. Non-family members are clearly eligible "sharees" for Chinese people. Differences in the reactions of sharees in good and bad sharing experiences were identified. Based on these findings, implications for bereavement care for Chinese are delineated. (Contains 4 tables.)

This study explores the bereavement process of Chinese persons in Hong Kong, with the focus on how they make meaning of the death as well as how they maintain a bond with the deceased. A review of video- and audiotapes of 52 bereaved persons in bereavement counseling pointed to how these concepts are reflected in key themes that appeared throughout these interviews. The way this bereaved population found meaning in the death was reflected in how they understood the cause of death, their observations at the death moment, their understanding of the life of the deceased after the death, the life of the bereaved after the death, and the burial and mourning rituals that were followed. The continuing bond the bereaved felt with the deceased was experienced by the bereaved as either initiated by the deceased, for example by the deceased appearing in dreams or initiated by the bereaved themselves in their talking with the deceased. These 2 aspects of the bereavement process seem to be similar to those found in other societies, but the ways in which they were manifested were unique to the Chinese culture. Based on these findings, the authors conclude with implications for intervention with this bereaved population.

Background : The mortuary plays an important, under-recognized role in end-of-life care. A ' Life-affirming strategy ' was introduced in the mortuary of a university hospital to enhance respect for the deceased and next-of-kin (NOK). Design: NOK who collected bodies in the mortuary of a university hospital participated in a survey. The satisfaction scores, needs and expectations were compared with a similar survey from 2015. Results: The overall experience for NOK improved significantly compared with 2015. The greatest improvement was achieved in 'mortuary environment', 'attitude of mortuary staff' and 'body viewing arrangement in the mortuary'. The perceived need for additional psychosocial support was significantly reduced. Conclusions: Results demonstrate success of the life-affirming strategy in enhancing end-of-life care for bereaved families. The person-centered approach modernizes and professionalizes mortuary services, with a positive impact on the deceased, NOK, mortuary staff, hospital administration and wider community. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify heterogeneous depressive symptom trajectories among the widowed elderly in China, to explore predictive variables of latent class membership, and to detect between-classes differences in life satisfaction across time. Method: Data of 198 individuals widowed between 2011 and 2013 were drawn from The China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. Latent class growth analysis was employed to identify depressive symptom trajectories across 2011, 2013, and 2015, and a three-step auxiliary approach was applied to detect predictive variables of latent class membership. Mixed Analysis of Variances was followed to make between-class comparisons on life satisfaction across time. Results: Four grieving trajectories were identified: resilient (54.6%), chronic grief (23.7%), depressed-improved (11.6%), and chronic depression (10.1%). Older age, living exclusively with spouse before widowhood, and agricultural Hukou were significant predictors of depressed-improved, chronic grief, and chronic depression patterns, respectively. Life satisfaction in all groups except for the resilient one remained stable across time, and that of the chronic depression group was significantly lower than those of all the remaining groups. Conclusion: Consistent depressive symptom trajectories during late-life widowhood exist across nations while the specific culture, values, and resources in the Chinese context may have contributed to a particularly high proportion of the chronic grief trajectory. More efforts should be made to identify patterns with predictors before support are provided, and interventions need to be tailored to target specific needs in each subgroup of the elderly during their transitions to widowhood. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore bereaved mothers' 2-year experiences of losing their only child in the 2008 Sichuan earthquake. Taking an interpretative phenomenological approach, this study interviewed six bereaved mothers four times (6 months, 12 months, 18 months, and 24 months) in Dujiangyan area in Sichuan Province. The findings suggest that these mothers' personal grief experiences evolved: initially, anger toward the cause of their children's deaths, following despair of meaningless life, guilt and regret, and finally yearning. Although their yearning and missing ebbed after 2 years, these mothers still had unresolved grief. These mothers also faced strained marital relationships and additional pressure from social interactions. This study illuminates that these mothers' personal grief experiences and their coping strategies corresponded to Chinese family and sociocultural context. [ABSTRACT FROM AUTHOR]

This study investigates Chinese people's opinions about the diagnosis of grief and the factors associated with their opinions. Among 1041 participants who completed the online survey, over half (56.5%) agreed that grief could be a mental disorder under certain circumstances, such as harm to self or others, functional impairment, and persistent grief. Primary reasons against the diagnosis were that grief is normal and its intensity decreases over time. A small proportion of opponents also expressed concerns about stigmatization resulting from labeling grief as being pathological. Younger, male, and full-time employed adults tended to support diagnosing grief as a mental disorder. [ABSTRACT FROM AUTHOR]

Background. Advance care planning (ACP) is considered to be an integral part of end-of-life care. This study explored the facilitators and barriers of ACP by consolidating the practice experiences of a group of healthcare professionals involved in an outreach end-of-life programme for older people living residential care homes for the elderly (RCHEs). Methods: Fourteen healthcare professionals participated in this qualitative study. They first completed a questionnaire to capture their views on ACP by describing a successful case. Then they took part in a focus group to discuss desired outcomes, facilitators, and barriers of ACP. Thematic analysis was applied to the questionnaire and focus group data. Results: Participants considered ACP a valuable opportunity for older people to express their care preferences. The resultant care plan provides families and care teams a useful reference for treatment decision-making. Facilitators included the collaborative ties among the community geriatric assessment team, RCHE staff, and the families of patients; dedicated and trained staff; and well-informed family members. Barriers included delayed referral, a lack of public acceptance and awareness, and overwhelming routines among healthcare professionals. Conclusions: Our findings underscore the multitude of individual, family, staff, and social factors affecting the dynamic process of ACP. An effective collaborative framework and professional training in communicating with distressed families are required. In addition, enhancing public awareness of comfort care and ACP is crucial. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore the grief experiences of mothers after they lost their children in the 2008 China earthquake. Informed by the dual process model, this study conducted in-depth interviews to explore how six bereaved mothers coped with such grief over a 2-year period. Right after the earthquake, these mothers suffered from intensive grief. They primarily coped with loss-oriented stressors. As time passed, these mothers began to focus on restoration-oriented stressors to face changes in life. This coping trajectory was a dynamic and integral process, which bereaved mothers oscillated between loss- and restoration-oriented stressors. This study offers insight in extending the existing empirical evidence of the dual process model. [ABSTRACT FROM AUTHOR]

Background and Objectives To examine the primary and secondary outcomes of a theory-driven group bereavement intervention for widowed older adults through a cluster-randomized controlled trial. Research Designs and Methods Twelve community centers providing health and social services for elderly people were randomly assigned to the experimental condition, the dual-process bereavement group intervention-Chinese (DPBGI-C) and to the control condition, the loss-oriented bereavement group intervention-Chinese (LOBGI-C). Both interventions comprised weekly, 2-hr sessions for 7 weeks followed by a 4-hr outing in the eighth week. Of 215 widowed older adults contacted and assessed, 125 eligible participants were interviewed three times—preintervention, postintervention, and at a 16-week follow-up—to assess complicated grief symptoms, anxiety, depression, loneliness, and social support. Results Using intention-to-treat analysis, both interventions produced improvements in grief, depression, and social support, but effect sizes were larger with the DPBGI-C. The participants in the DPBGI-C condition also reported reduced anxiety, emotional loneliness, and social loneliness, whereas those in the LOBGI-C condition did not. There were interactions between intervention type and time with respect to grief, anxiety, emotional loneliness, and social loneliness. Discussion and Implications Although traditional LOBGI-C can help to reduce grief and depression in bereaved older adults, the DPBGI-C was found to be superior as it had a greater and more extensive impact on outcomes. This is the first study of the effectiveness of this evidence-based, theory-driven intervention for widowed Chinese older adults and has implications for theory building and practice. [ABSTRACT FROM AUTHOR]

We conducted a scoping review of quantitative studies on professional caregivers' bereavement after patients' deaths following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found 12 studies involving 1317 professional caregivers that met inclusion criteria. Professional caregivers commonly had moderate, and sometimes long-term, bereavement reactions after patients' death. The evidence of factors affecting profession grief is inconclusive. Previous researchers extensively used the framework of understanding familial bereavement for analyzing the professional caregivers' bereavement, which we found to be inadequate. We call for a clear definition of professional bereavement and the development of a specific measurement tool. [ABSTRACT FROM AUTHOR]

Background: Based on the cognitive theory, anxiety arising from the awareness of death and dying may activate dysfunctional attitudes, which may then reduce quality of life. This study examined the interdependence and the mediating role of dysfunctional attitudes on the relationship between death anxiety and quality of life among patients with lung cancer and their caregivers.Methods: From March 2016 to April 2017, 173 pairs of patients and their caregivers enrolled in a randomized controlled trial of psychosocial support. Using the baseline data, actor-partner interdependence modeling was used to analyze the relationships among death anxiety, dysfunctional attitudes, and quality of life.Results: In patients, death anxiety was related to dependency (β = .51) and self-control (β = -.37); achievement (β = -.21) and self-control (β = .34) were related to quality of life. Among caregivers, death anxiety was related to all 3 dysfunctional attitudes of their own (βs = .23 to.32); dependency (β = -.22) was associated with quality of life. Caregiver quality of life was also associated with patient self-control (β = .22) and achievement (β = -.18). Patient self-control mediated the links between patient death anxiety with both patient and caregiver quality of life. The relationship between death anxiety and quality of life was mediated by dependency in caregivers.Discussion: Death anxiety influences dysfunctional attitudes and quality of life of both patients and caregivers. Our results support the relevance of dysfunctional attitudes in understanding the impact of death anxiety and underscore the need for parallel psychosocial interventions. [ABSTRACT FROM AUTHOR]

Background: Life review interventions have been used to alleviate psycho-spiritual distress in people near the end of life. However, their effectiveness remains inconclusive. Aim: To evaluate the effects of therapeutic life review on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer. Design: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Data sources: Five databases were searched from their respective inception through February 2017 for relevant randomized controlled trials. The effects of therapeutic life review were pooled across the trials. Standardized mean differences were calculated for the pooled effects. Heterogeneity was assessed using the I2 test. Study quality was assessed using the Cochrane criteria. Results: Eight randomized controlled trials met the inclusion criteria. The pooled results suggested a desirable effect of therapeutic life review on the meaning of life domain of spiritual well-being (standardized mean difference = 0.33; 95% confidence interval, 0.12 to 0.53), general distress (standardized mean difference = −0.32; 95% confidence interval, −0.55 to −0.09), and overall quality of life (standardized mean difference = 0.35; 95% confidence interval, 0.15 to 0.56) when compared to usual care only. Of the three outcomes examined, only the pooled effect on overall quality of life remained statistically significant at follow-ups up to 3 months after the intervention (standardized mean difference = 0.82; 95% confidence interval, 0.47 to 1.18). Conclusions: Therapeutic life review is potentially beneficial for people near the end of life. However, the results should be interpreted with caution due to the limited number of randomized controlled trials and associated methodological weaknesses. Further rigorously designed randomized controlled trials are warranted. [ABSTRACT FROM AUTHOR]

Background: Advance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity. Although a number of studies have documented social workers' attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers' perspectives and experiences regarding implementation of advance care planning. Methods: Six databases were searched for peer-reviewed research papers from their respective inception through December 2016. All of the resulting studies relevant to both advance care planning and social worker were examined. The findings of relevant studies were synthesized thematically. Results: Thirty-one articles met the eligibility criteria. Six research themes were identified: social workers' attitudes toward advance care planning; social workers' knowledge, education and training regarding advance care planning; social workers' involvement in advance care planning; social workers' perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities. Conclusions: This study provides useful knowledge for implementing advance care planning through illustrating social workers' perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers' involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts. [ABSTRACT FROM AUTHOR]